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Delirium READI:(Researching Efficient Approaches for Delirium Identification): Clinician experiences and perspectives when screening for delirium in persons with dementia
Author(s) -
Fick Donna Marie,
Boltz Marie,
Husser Erica,
Ngo Long H,
Shrestha Priyanka,
Inouye Sharon K,
Marcantonio Edward R
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039897
Subject(s) - delirium , dementia , thematic analysis , medicine , qualitative research , denial , psychiatry , cognition , nursing , psychology , disease , psychotherapist , social science , pathology , sociology
Background Less than half of all delirium in persons with dementia is identified. By 2050, 14 million older persons in the United States will have dementia. These individuals are more likely to be hospitalized than those without dementia, and more than 50% will experience delirium during hospitalization. Previous work suggests that delirium may accelerate the clinical course and trajectory of cognitive decline, and is associated with worse outcomes and suffering. Despite this evidence, we know little about clinician experience with screening and management of delirium superimposed on dementia (DSD). Therefore, we interviewed hospital‐based clinicians to inform implementation of hospital‐wide systematic delirium identification, including clinician knowledge and experience with DSD. Method We conducted in‐depth qualitative interviews in person and over the phone as part of a larger mixed methods study of N=934 (535 older adults and 399 clinicians) that tested a two‐step process for delirium identification using the Ultra‐brief two item delirium screen (UB‐2) and 3D‐CAM. We report on the qualitative analysis of 14 interviews with 6 physicians, 4 registered nurses and 4 nursing assistants who had screened for DSD in the larger study at two hospital study sites. Data were analyzed using coding and thematic analysis (Creswell, 2016). Interviews ranged in length from 14 to 47 minutes. Result Although clinicians valued the quick tools to detect delirium, they described skepticism and challenges in evaluating DSD. One physician noted, "Many times I think healthcare providers, whether it's a doctor, a nurse, whatever, we just chalk up behavior in the hospital, "Oh, they're demented. They have dementia. You expect this [confusion]... People who are confused, they get up and they fall. Preliminary themes identified were: skepticism, bias and low expectations, stage of dementia as important, fluctuation and repeated screening, role of family in screening, nonverbal communication and cues, and knowing the person. Conclusion Our study suggests that clinicians lack knowledge and confidence in assessing for and managing DSD. Clinicians may still consider DSD to be “normal” in hospitalized patients with dementia. Future implementation studies should also address attitudes and knowledge regarding delirium assessment, management and prevention in DSD.